We report the case of a 16-year-old male patient who sustained an open fracture of the right medial malleolus in a traffic accident. Physical examination revealed a comminuted medial malleolus fracture with bone and medial soft tissue defects. The distal part of the medial malleolus was divided into anterior and posterior bone fragments. The anterior fragment exhibited no vascularity, which was more likely to cause nonunion and bone atrophy after osteosynthesis. Therefore, we considered the vascularized periosteum, which had significant osteogenic potential, to be effective for successful bone union. We performed open reduction and internal fixation using a bone graft from the iliac bone. The periosteum vascularized by the distal part of the anterior tibial artery was elevated from the anterodistal side of the tibia and wrapped around the fracture site. The fracture united completely within two months after surgery, and pathological examination revealed that the osteocytes survived even though the anterior fragment had poor vascularity. Vascularized periosteal grafts may be useful for bone reconstruction as they facilitate the preservation of osteochondral fragments with poor vascularity.
